Penetrating cardiac trauma. Experience with thirty-four patients in a hospital without cardiopulmonary bypass capability.

A review of thirty-four consecutive penetrating wounds of the heart is presented. Thirty-one patients were in shock at the time of admission, and fourteen had no obtainable blood pressure and were comatose or moribund. The weapon used, clinical status of the patient on arrival, size of the cardiac wound, and presence of associated injuries affected the mortality rate. Seven of the eight deaths were considered unpreventable due to clinical deterioration by the time of arrival. Clinical recognition of cardiac tamponade is stressed. Early open thoracotomy and closure of the cardiac wound is advocated as the preferred method of treating this injury. No patient was lost due to lack of cardiopulmonary bypass capability.